Media Consent Form

I (parent/caregiver) hereby consent to Blue Mountains Jiu Jitsu Academy and its Partners to take, or have taken bu others, photographs, digital images and /or audio, and /or video footage (the images) of the student named below, and to store the images, make copies of the images and publish the images in any form, in whole or in part, and distribute them in any medium including, but not limited to, print media, the internet, any storage device (usb, cd-rom), other multi-media uses or graphic representation, cinematography or video.

I consent to the images being used by Blue Mountains Jiu Jitsu Academy, or provided to the the others for the following purposes only:

* General news, or promotion of the event on TV, Radio, in newspapers, in trade and other journals and websites and the internet.

* The production of resources/programs that will assist Blue Mountains Jiu Jitsu Academy in its educational mission,

* Promoting and advertising the resulting educational products/resources.

Blue Mountains Jiu Jitsu Academy undertake not to use any images in a way that would cause embarrassment, or misrepresent the intent of the student's participation.

I understand that neither I nor the student will be paid for giving this permission and hereby waive any claim that I or we may have had for remuneration, residuals, royalties, or any other payment in respect of use of the images.

I agree that Blue Mountains Jiu Jitsu Academy and its Partners shall not be bound to make any use of the images.